AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
AACN PCCN Practice Test Questions and Answers
2026/2027
175 Verified Questions & Answers — Aligned with the AACN PCCN Examination Content Outline
(2026/2027)
Generated: September 18, 2026 | Format: Multiple Choice (4 options, one correct) | Total Items: 175
Section Topic Coverage Items
Section 1 Cardiovascular System Q1–Q40
Section 2 Hemodynamic Monitoring and Shock States Q41–Q62
Section 3 Pulmonary System Q63–Q90
Section 4 Neurological System Q91–Q112
Section 5 Renal and Endocrine Systems Q113–Q135
Section 6 Gastrointestinal and Hematologic Systems Q136–Q150
Section 7 Multisystem, Psychosocial, Ethical, and Professional Practice Q151–Q175
Directions: This practice test mirrors the rigor and content coverage of the AACN Progressive Care Certified
Nurse (PCCN) examination. Each of the 175 multiple-choice items presents four options (A–D) with exactly one
correct response. Items are calibrated to a cognitive distribution of approximately 25% recall, 50% application,
and 25% analysis, and weighted per the AACN PCCN test plan: Clinical Judgment (75%), Professional Caring
(15%), and Clinical Inquiry (10%). Approximately 80% of items are scenario-based, requiring identification of
advanced hemodynamic interpretation, rhythm analysis, ABG interpretation, medication titration, prioritization
(ABC, Maslow, safety), "next best action" and "most likely complication" reasoning, and AACN Synergy Model
application. Approximately 20% assess direct recall of pharmacology, guidelines, and procedures. After each item,
the correct answer and a 3–4 sentence rationale are provided, integrating evidence-based practice from AACN,
SCCM (Surviving Sepsis Campaign), AHA/ACC, and ARDSNet. Use this document as a self-check study guide
aligned with 2026/2027 AACN PCCN examination standards.
Section 1: Cardiovascular System
ACS, Heart Failure, Dysrhythmias, Valvular Disease, Cardiomyopathies, and Vascular Disorders | Items
Q1–Q40
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 1
,AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Q1.
A 58-year-old male presents to the ED with 45 minutes of crushing substernal chest pressure radiating to the left
arm, diaphoresis, and nausea. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF with
reciprocal depression in I and aVL. Which coronary artery is most likely occluded, and what is the priority
intervention?
A. Left anterior descending; administer thrombolytics and arrange urgent PCI
B. Right coronary artery; arrange immediate reperfusion therapy (primary PCI preferred within 90
minutes door-to-balloon) [CORRECT]
C. Circumflex artery; administer IV metoprolol and monitor
D. Left main coronary artery; initiate intra-aortic balloon pump counterpulsation
Correct Answer: B
Rationale: ST elevation in II, III, and aVF with reciprocal changes in I and aVL indicates an inferior wall STEMI, most
commonly caused by right coronary artery (RCA) occlusion. The priority is immediate reperfusion via primary PCI
(door-to-balloon ≤90 minutes) or fibrinolytics if PCI is unavailable within 120 minutes. The LAD supplies the anterior
wall (V1-V4), the circumflex supplies the lateral wall (I, aVL, V5-V6), and left main occlusion produces widespread ST
elevation with cardiogenic shock.
Q2.
A patient is receiving a fibrinolytic (alteplase) for STEMI. One hour into the infusion, the patient becomes acutely
confused and unresponsive, with unilateral pupil dilation. Which action should the nurse take FIRST?
A. Increase the alteplase infusion rate to complete the dose
B. Stop the alteplase infusion immediately, notify the provider, and prepare for emergent CT scan and
cryoprecipitate administration [CORRECT]
C. Administer IV labetalol for blood pressure control
D. Assess oxygen saturation and apply supplemental oxygen
Correct Answer: B
Rationale: Acute neurologic changes during fibrinolytic therapy signal probable intracranial hemorrhage, a
life-threatening complication. The infusion must be stopped immediately, the provider notified, and emergent
non-contrast CT ordered. Cryoprecipitate, fresh frozen plasma, and factor reversal may be required. Continuing the
infusion increases hemorrhage severity. Labetalol addresses BP but does not treat the cause, and oxygen does not address
the underlying emergency.
Q3.
A patient with NSTEMI is started on aspirin, ticagrelor, and unfractionated heparin. Three hours later, the patient
develops sudden severe dyspnea, hypotension (BP 78/44), and bilateral crackles. The ECG shows new ST
depression in V1-V3. What is the most likely cause?
A. Anaphylactic reaction to ticagrelor
B. Acute posterior wall ischemia with cardiogenic shock [CORRECT]
C. Heparin-induced bleeding causing hypovolemia
D. Acute decompensated heart failure from volume overload
Correct Answer: B
Rationale: ST depression in V1-V3 with anterior T-wave changes and hemodynamic collapse suggests a true posterior
STEMI (reciprocal to posterior ST elevation), causing acute ischemic mitral regurgitation or cardiogenic shock.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 2
,AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Posterior MI often coexists with inferior or right ventricular involvement. Anaphylaxis would present with urticaria and
bronchospasm, heparin bleeding would be more gradual, and isolated heart failure without new ischemia does not
explain the ECG pattern.
Q4.
A 67-year-old female with a history of hypertension and diabetes presents with acute decompensated heart failure.
BP is 88/52, HR 118, RR 28, SpO2 88% on room air. Bilateral crackles, JVD, and cool extremities are present.
The PA catheter shows: PCWP 28 mmHg, CI 1.8 L/min/m2, SVR 1900 dynes/sec/cm5. Which hemodynamic
profile is this, and what is the priority management?
A. Forrester Class II (warm/dry); administer IV furosemide
B. Forrester Class IV (cold/wet); initiate inotrope (dobutamine or milrinone) plus vasodilator therapy if
BP tolerates, with mechanical support consideration [CORRECT]
C. Forrester Class III (warm/wet); give IV morphine and nitrates
D. Forrester Class I (warm/dry); continue diuretic therapy
Correct Answer: B
Rationale: Low CI (1.8), high PCWP (28), and high SVR (1900) characterize Forrester Class IV (cold/wet) cardiogenic
shock. The priority is to improve cardiac output with inotropes (dobutamine/milrinone), reduce congestion with
diuretics, and consider mechanical circulatory support (IABP/Impella) if pharmacologic therapy fails. Vasodilators
alone would worsen hypotension. Diuretics alone are insufficient given the low output state. This patient has shock, not
simply volume overload.
Q5.
A patient with acute decompensated heart failure has a serum potassium of 2.9 mEq/L and is receiving IV
furosemide 80 mg boluses. The patient develops frequent PVCs and short runs of NSVT. Which intervention is
MOST appropriate?
A. Administer IV amiodarone 150 mg bolus
B. Replete potassium and magnesium, switch furosemide to a continuous infusion to minimize
fluctuations, and consider potassium-sparing diuretic [CORRECT]
C. Discontinue furosemide and start IV normal saline
D. Administer IV metoprolol 5 mg push
Correct Answer: B
Rationale: Hypokalemia from loop diuretics is a major trigger for ventricular ectopy in heart failure. The priority is to
replete potassium and magnesium (cofactor), use continuous furosemide infusion for smoother diuresis, and consider a
potassium-sparing agent (spironolactone) for CHF patients. Amiodarone may be needed for sustained VT but does not
address the underlying electrolyte deficit. Stopping furosemide would worsen heart failure, and metoprolol is
contraindicated with severe hypokalemia.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 3
, AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Q6.
A patient with HFrEF (EF 25%) on carvedilol, lisinopril, and spironolactone is admitted with acute decompensated
heart failure. Which medication should the nurse anticipate being held during the acute decompensated phase?
A. Lisinopril
B. Carvedilol [CORRECT]
C. Spironolactone
D. Furosemide
Correct Answer: B
Rationale: Beta-blockers (carvedilol) should be held or reduced during acute decompensated heart failure because their
negative inotropic effects can worsen the low-output state. They should be restarted once the patient is euvolemic and
stable. ACE inhibitors, ARBs, and MRA may be continued cautiously or held briefly depending on BP and renal
function. Diuretics are essential for congestion management and should not be held.
Q7.
A patient is admitted with new-onset atrial fibrillation with rapid ventricular response (HR 162, BP 96/58,
complaining of chest pain and dyspnea). Which is the PRIORITY intervention?
A. Administer IV diltiazem 0.25 mg/kg for rate control
B. Perform immediate synchronized cardioversion [CORRECT]
C. Administer IV amiodarone 150 mg load
D. Administer IV metoprolol 5 mg push
Correct Answer: B
Rationale: Unstable atrial fibrillation (hypotension, chest pain suggesting ischemia, dyspnea) requires immediate
synchronized cardioversion per ACLS guidelines. Rate-control agents (diltiazem, metoprolol) may worsen hypotension
and delay definitive treatment. Amiodarone is used for stable AF or pharmacologic cardioversion. Synchronized
cardioversion (100J biphasic) is the priority for hemodynamic instability.
Q8.
A patient's cardiac monitor shows a regular, narrow-complex tachycardia at 180 bpm with no visible P waves. The
patient is alert with BP 110/70. Vagal maneuvers are unsuccessful. Which medication is the drug of choice?
A. IV adenosine 6 mg rapid push followed by 12 mg if needed [CORRECT]
B. IV amiodarone 150 mg over 10 minutes
C. IV diltiazem 0.25 mg/kg
D. IV metoprolol 5 mg
Correct Answer: A
Rationale: Regular narrow-complex tachycardia without visible P waves is most likely AV nodal reentrant tachycardia
(AVNRT) or AVRT. Adenosine is the drug of choice for diagnosis and termination, given as 6 mg rapid IV push
followed by a 12 mg dose if needed. Diltiazem and metoprolol are alternatives but slower in onset. Amiodarone is not
first-line for stable SVT.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 4
AACN PCCN Practice Test Questions and Answers
2026/2027
175 Verified Questions & Answers — Aligned with the AACN PCCN Examination Content Outline
(2026/2027)
Generated: September 18, 2026 | Format: Multiple Choice (4 options, one correct) | Total Items: 175
Section Topic Coverage Items
Section 1 Cardiovascular System Q1–Q40
Section 2 Hemodynamic Monitoring and Shock States Q41–Q62
Section 3 Pulmonary System Q63–Q90
Section 4 Neurological System Q91–Q112
Section 5 Renal and Endocrine Systems Q113–Q135
Section 6 Gastrointestinal and Hematologic Systems Q136–Q150
Section 7 Multisystem, Psychosocial, Ethical, and Professional Practice Q151–Q175
Directions: This practice test mirrors the rigor and content coverage of the AACN Progressive Care Certified
Nurse (PCCN) examination. Each of the 175 multiple-choice items presents four options (A–D) with exactly one
correct response. Items are calibrated to a cognitive distribution of approximately 25% recall, 50% application,
and 25% analysis, and weighted per the AACN PCCN test plan: Clinical Judgment (75%), Professional Caring
(15%), and Clinical Inquiry (10%). Approximately 80% of items are scenario-based, requiring identification of
advanced hemodynamic interpretation, rhythm analysis, ABG interpretation, medication titration, prioritization
(ABC, Maslow, safety), "next best action" and "most likely complication" reasoning, and AACN Synergy Model
application. Approximately 20% assess direct recall of pharmacology, guidelines, and procedures. After each item,
the correct answer and a 3–4 sentence rationale are provided, integrating evidence-based practice from AACN,
SCCM (Surviving Sepsis Campaign), AHA/ACC, and ARDSNet. Use this document as a self-check study guide
aligned with 2026/2027 AACN PCCN examination standards.
Section 1: Cardiovascular System
ACS, Heart Failure, Dysrhythmias, Valvular Disease, Cardiomyopathies, and Vascular Disorders | Items
Q1–Q40
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 1
,AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Q1.
A 58-year-old male presents to the ED with 45 minutes of crushing substernal chest pressure radiating to the left
arm, diaphoresis, and nausea. The 12-lead ECG shows ST-segment elevation in leads II, III, and aVF with
reciprocal depression in I and aVL. Which coronary artery is most likely occluded, and what is the priority
intervention?
A. Left anterior descending; administer thrombolytics and arrange urgent PCI
B. Right coronary artery; arrange immediate reperfusion therapy (primary PCI preferred within 90
minutes door-to-balloon) [CORRECT]
C. Circumflex artery; administer IV metoprolol and monitor
D. Left main coronary artery; initiate intra-aortic balloon pump counterpulsation
Correct Answer: B
Rationale: ST elevation in II, III, and aVF with reciprocal changes in I and aVL indicates an inferior wall STEMI, most
commonly caused by right coronary artery (RCA) occlusion. The priority is immediate reperfusion via primary PCI
(door-to-balloon ≤90 minutes) or fibrinolytics if PCI is unavailable within 120 minutes. The LAD supplies the anterior
wall (V1-V4), the circumflex supplies the lateral wall (I, aVL, V5-V6), and left main occlusion produces widespread ST
elevation with cardiogenic shock.
Q2.
A patient is receiving a fibrinolytic (alteplase) for STEMI. One hour into the infusion, the patient becomes acutely
confused and unresponsive, with unilateral pupil dilation. Which action should the nurse take FIRST?
A. Increase the alteplase infusion rate to complete the dose
B. Stop the alteplase infusion immediately, notify the provider, and prepare for emergent CT scan and
cryoprecipitate administration [CORRECT]
C. Administer IV labetalol for blood pressure control
D. Assess oxygen saturation and apply supplemental oxygen
Correct Answer: B
Rationale: Acute neurologic changes during fibrinolytic therapy signal probable intracranial hemorrhage, a
life-threatening complication. The infusion must be stopped immediately, the provider notified, and emergent
non-contrast CT ordered. Cryoprecipitate, fresh frozen plasma, and factor reversal may be required. Continuing the
infusion increases hemorrhage severity. Labetalol addresses BP but does not treat the cause, and oxygen does not address
the underlying emergency.
Q3.
A patient with NSTEMI is started on aspirin, ticagrelor, and unfractionated heparin. Three hours later, the patient
develops sudden severe dyspnea, hypotension (BP 78/44), and bilateral crackles. The ECG shows new ST
depression in V1-V3. What is the most likely cause?
A. Anaphylactic reaction to ticagrelor
B. Acute posterior wall ischemia with cardiogenic shock [CORRECT]
C. Heparin-induced bleeding causing hypovolemia
D. Acute decompensated heart failure from volume overload
Correct Answer: B
Rationale: ST depression in V1-V3 with anterior T-wave changes and hemodynamic collapse suggests a true posterior
STEMI (reciprocal to posterior ST elevation), causing acute ischemic mitral regurgitation or cardiogenic shock.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 2
,AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Posterior MI often coexists with inferior or right ventricular involvement. Anaphylaxis would present with urticaria and
bronchospasm, heparin bleeding would be more gradual, and isolated heart failure without new ischemia does not
explain the ECG pattern.
Q4.
A 67-year-old female with a history of hypertension and diabetes presents with acute decompensated heart failure.
BP is 88/52, HR 118, RR 28, SpO2 88% on room air. Bilateral crackles, JVD, and cool extremities are present.
The PA catheter shows: PCWP 28 mmHg, CI 1.8 L/min/m2, SVR 1900 dynes/sec/cm5. Which hemodynamic
profile is this, and what is the priority management?
A. Forrester Class II (warm/dry); administer IV furosemide
B. Forrester Class IV (cold/wet); initiate inotrope (dobutamine or milrinone) plus vasodilator therapy if
BP tolerates, with mechanical support consideration [CORRECT]
C. Forrester Class III (warm/wet); give IV morphine and nitrates
D. Forrester Class I (warm/dry); continue diuretic therapy
Correct Answer: B
Rationale: Low CI (1.8), high PCWP (28), and high SVR (1900) characterize Forrester Class IV (cold/wet) cardiogenic
shock. The priority is to improve cardiac output with inotropes (dobutamine/milrinone), reduce congestion with
diuretics, and consider mechanical circulatory support (IABP/Impella) if pharmacologic therapy fails. Vasodilators
alone would worsen hypotension. Diuretics alone are insufficient given the low output state. This patient has shock, not
simply volume overload.
Q5.
A patient with acute decompensated heart failure has a serum potassium of 2.9 mEq/L and is receiving IV
furosemide 80 mg boluses. The patient develops frequent PVCs and short runs of NSVT. Which intervention is
MOST appropriate?
A. Administer IV amiodarone 150 mg bolus
B. Replete potassium and magnesium, switch furosemide to a continuous infusion to minimize
fluctuations, and consider potassium-sparing diuretic [CORRECT]
C. Discontinue furosemide and start IV normal saline
D. Administer IV metoprolol 5 mg push
Correct Answer: B
Rationale: Hypokalemia from loop diuretics is a major trigger for ventricular ectopy in heart failure. The priority is to
replete potassium and magnesium (cofactor), use continuous furosemide infusion for smoother diuresis, and consider a
potassium-sparing agent (spironolactone) for CHF patients. Amiodarone may be needed for sustained VT but does not
address the underlying electrolyte deficit. Stopping furosemide would worsen heart failure, and metoprolol is
contraindicated with severe hypokalemia.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 3
, AACN PCCN Practice Test — Updated 2026/2027 (Verified Answers) Progressive Care Certified Nurse
Q6.
A patient with HFrEF (EF 25%) on carvedilol, lisinopril, and spironolactone is admitted with acute decompensated
heart failure. Which medication should the nurse anticipate being held during the acute decompensated phase?
A. Lisinopril
B. Carvedilol [CORRECT]
C. Spironolactone
D. Furosemide
Correct Answer: B
Rationale: Beta-blockers (carvedilol) should be held or reduced during acute decompensated heart failure because their
negative inotropic effects can worsen the low-output state. They should be restarted once the patient is euvolemic and
stable. ACE inhibitors, ARBs, and MRA may be continued cautiously or held briefly depending on BP and renal
function. Diuretics are essential for congestion management and should not be held.
Q7.
A patient is admitted with new-onset atrial fibrillation with rapid ventricular response (HR 162, BP 96/58,
complaining of chest pain and dyspnea). Which is the PRIORITY intervention?
A. Administer IV diltiazem 0.25 mg/kg for rate control
B. Perform immediate synchronized cardioversion [CORRECT]
C. Administer IV amiodarone 150 mg load
D. Administer IV metoprolol 5 mg push
Correct Answer: B
Rationale: Unstable atrial fibrillation (hypotension, chest pain suggesting ischemia, dyspnea) requires immediate
synchronized cardioversion per ACLS guidelines. Rate-control agents (diltiazem, metoprolol) may worsen hypotension
and delay definitive treatment. Amiodarone is used for stable AF or pharmacologic cardioversion. Synchronized
cardioversion (100J biphasic) is the priority for hemodynamic instability.
Q8.
A patient's cardiac monitor shows a regular, narrow-complex tachycardia at 180 bpm with no visible P waves. The
patient is alert with BP 110/70. Vagal maneuvers are unsuccessful. Which medication is the drug of choice?
A. IV adenosine 6 mg rapid push followed by 12 mg if needed [CORRECT]
B. IV amiodarone 150 mg over 10 minutes
C. IV diltiazem 0.25 mg/kg
D. IV metoprolol 5 mg
Correct Answer: A
Rationale: Regular narrow-complex tachycardia without visible P waves is most likely AV nodal reentrant tachycardia
(AVNRT) or AVRT. Adenosine is the drug of choice for diagnosis and termination, given as 6 mg rapid IV push
followed by a 12 mg dose if needed. Diltiazem and metoprolol are alternatives but slower in onset. Amiodarone is not
first-line for stable SVT.
AACN Synergy Model | Clinical Judgment 75% | Professional Caring 15% | Clinical Inquiry 10% Page 4
